The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Lynn Boschloo^{1

2}, Ella Bekhuis², Erica S Weitz¹, Mirjam Reijnders¹, Robert J DeRubeis³, Sona Dimidjian⁴, David L Dunner⁵, Boadie W Dunlop⁶, Ulrich Hegerl⁷, Steven D Hollon⁸, Robin B Jarrett⁹, Sidney H Kennedy¹⁰, Jeanne Miranda¹¹, David C Mohr¹², Anne D Simons¹³, Gordon Parker¹⁴, Frank Petrak¹⁵, Stephan Herpertz¹⁵, Lena C Quilty^{10

16}, A John Rush^{17

18

19}, Zindel V Segal²⁰, Jeffrey R Vittengl²¹, Robert A Schoevers², Pim Cuijpers¹

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
² Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA.
⁵ Center for Anxiety and Depression, Mercer Island, Washington, WA, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁷ Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
⁸ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
⁹ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹¹ Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA.
¹² Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹³ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
¹⁴ School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
¹⁵ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr University Bochum, Bochum, Germany.
¹⁶ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
¹⁷ Duke-National University of Singapore Graduate Medical School, Singapore.
¹⁸ Department of Psychiatry, Duke Medical School, Durham, NC, USA.
¹⁹ Texas Tech University Health Sciences Center, Permian Basin, TX, USA.
²⁰ Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.
²¹ Department of Psychology, Truman State University, Kirksville, MO, USA.

PMID: 31059603
PMCID: PMC6502416
DOI: 10.1002/wps.20630

The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Lynn Boschloo et al. World Psychiatry. 2019 Jun.

. 2019 Jun;18(2):183-191.

doi: 10.1002/wps.20630.

Authors

Affiliations

¹ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
² Department of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA.
⁵ Center for Anxiety and Depression, Mercer Island, Washington, WA, USA.
⁶ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁷ Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
⁸ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
⁹ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹¹ Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA.
¹² Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹³ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
¹⁴ School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
¹⁵ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr University Bochum, Bochum, Germany.
¹⁶ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
¹⁷ Duke-National University of Singapore Graduate Medical School, Singapore.
¹⁸ Department of Psychiatry, Duke Medical School, Durham, NC, USA.
¹⁹ Texas Tech University Health Sciences Center, Permian Basin, TX, USA.
²⁰ Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.
²¹ Department of Psychology, Truman State University, Kirksville, MO, USA.

PMID: 31059603
PMCID: PMC6502416
DOI: 10.1002/wps.20630

Abstract

A recent individual patient data meta-analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM-defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17-item Hamilton Rating Scale for Depression. Five symptoms (i.e., "depressed mood" , "feelings of guilt" , "suicidal thoughts" , "psychic anxiety" and "general somatic symptoms") showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from .13 to .16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on "depressed mood" , were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom-specific efficacy could help in identifying those patients who, based on their pre-treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of .30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom-oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in "precision psychiatry" .

Keywords: Depression; antidepressant medication; cognitive behavioral therapy; depressed mood; depressive symptoms; feelings of guilt; general somatic symptoms; precision psychiatry; psychic anxiety; suicidal thoughts.

PubMed Disclaimer

Figures

**Figure 1**
Direct and indirect symptom‐specific effects of antidepressant medication (ADM) vs. cognitive behavioral therapy (CBT). Treatment type is represented by the square (TR), and individual symptoms as circles. Black lines indicate direct connections between treatment condition and improvements in individual symptoms (i.e., direct treatment effects), whereas grey lines indicate connections between improvements in individual symptoms (i.e., potential indirect treatment effects). Thicker lines represent stronger connections. Darker circles represent stronger effects of ADM over CBT. The network is presented at γ=0.25.

**Figure 2**
Stratification based on increasing scores on a specific pre‐treatment severity indicator calculated by summing the five symptoms that responded the most to antidepressant medication (ADM) relative to cognitive behavioral therapy (CBT). * Cohen's d=.30.

**Figure 3**
Stratification based on increasing scores on a specific pre‐treatment severity indicator calculated by summing the five symptoms that responded the least to antidepressant medication (ADM) relative to cognitive behavioral therapy (CBT). * Cohen's d=.33.

See this image and copyright information in PMC

References

1. Mulrow CD, Williams JW Jr, Chiquette E et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000;108:54‐64. - PubMed
1. Churchill R, Hunot V, Corney R et al. A systematic review of controlled trials of the effectiveness and cost‐effectiveness of brief psychological treatments for depression. Health Technol Assess 2001;5:1‐173. - PubMed
1. Butler AC, Chapman JE, Forman EM et al. The empirical status of cognitive‐behavioral therapy: a review of meta‐analyses. Clin Psychol Rev 2006;26:17‐31. - PubMed
1. Cuijpers P, Berking M, Andersson G et al. A meta‐analysis of cognitive‐behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry 2013;58:376‐85. - PubMed
1. Weitz ES, Hollon SD, Twisk J et al. Baseline depression severity as a moderator of depression outcomes between cognitive behavioral therapy versus pharmacotherapy. An individual patient data meta‐analysis. JAMA Psychiatry 2015;72:1102‐9. - PubMed

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Affiliations

The symptom-specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta-analysis

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources